Implementation Council Annual Report - Draft
One Care Implementation Council Annual Report
2014
Table of Contents
Letter from the Chair 3
One Care: MassHealth plus Medicare 6
Implementation Council Background 6
Implementation Council Charge 6
Roles and Responsibilities 7
Members/Composition 7
2014 Year in Review 9
Meetings 9
Subcommittees & Workgroups 10
2014 Work Plan 11
Activities and Accomplishments 11
Soliciting input from stakeholders 12
Participating in the development of public education and outreach campaigns 12
Advising EOHHS - Examining One Care early implementation 13
Examining access to services 14
Ongoing Council Member Priorities and Activities 15
Conclusion 17
What Implementation Council Members have to say 18
Attachment A: Approved Motions 20
Attachment B: Schedule of 2014 Implementation Council Meetings 35
Attachment C: 2014 Workplan: Review of Activities 36
Attachment D: DRAFT Quarterly Report on the Performance of One Care Program 40
Letter from the Chair
Dear Secretary Sudders,
It is an honor to represent the Massachusetts One Care Implementation Council (Council) in the submission of the 2014 Annual Report. 2014 was an important year in the life of the One Care demonstration. It was marked by a number of successes, success made in the face of many challenges.
First and foremost, One Care has enrolled over 17,000 dual eligibles. This growth is unprecedented in Massachusetts. When compared to the Senior Care Options Program (SCO), One Care grew to over 17,000 enrollees in one year while SCO took close to ten years to reach similar numbers. In terms of scale, 17,000 enrollees is a significant percentage of the overall population eligible to participate in One Care. Only three plans are participating in the demonstration and they enrolled this number of participants in the face of a number of barriers. These barriers included financial challenges, the issue of proxy rating categories that required adjustments to higher need rating categories, and challenges in reaching new enrollees and conducting comprehensive assessments for up to 30% of enrollees within the 90-day period required by MassHealth.
An additional barrier to increasing scale is the number of potential enrollees who have opted out of One Care because their primary care providers are either part of systems that do not allow them to participate in the program or have actively decided not to participate in the program. Left in an untenable position of having to choose between continuity of care with a trusted primary care provider and the opportunity to obtain enhanced services under One Care, many potential enrollees are staying with their current providers rather than enrolling in an untested managed care system.
At this point, it is too early to assess the overall quality of the plans, but they are to be lauded for having entered the field of providing integrated care to the state’s most complex population with the thinnest margin of health and greatest medical and long term services and supports (LTSS) needs. In addition, anecdotal consumer input and plan reports indicate that One Care plans are developing real-time innovative interventions to identify and address heretofore unmet needs of dual eligibles in the fee-for-service system. Early indicators show overall enrollee satisfaction with One Care plans. Over 90% reported that their Care Team cared about their preferences and treated them with respect. Most also reported that their medical needs were being met and over 85% are satisfied with their Primary Care Provider and Care Coordinator. Although satisfaction with the Independent Living and Long Term Services and Supports (LTS) Coordinator is even higher, with 93% reporting satisfaction, many individuals were never offered this new and potentially life changing service.
As the primary official body representing the voice of consumers in One Care, the Council strives to protect consumers. It does so by listening to the concerns of consumers and guiding MassHealth towards a system of greater transparency and measurement of quality in the program from a consumer-centric perspective, while also recognizing the importance of provider satisfaction and commitment to the program. Unique in its own right as a national model, the Council has provided important guidance to MassHealth. It has passed motions requesting MassHealth to reconsider auto assignment and provide more information about the decision-making process in response to concerns raised by consumers about: the capacity of plans, the need to develop transparent objective measures of plan capacity, and quality that supports sustainable growth of One Care. The Council passed a motion that resulted in its providing support to the Ombudsman Office by writing a letter to request increased funding to the Centers for Medicare and Medicaid Services which was ultimately approved. As a result of other motions brought forth by the Council regarding requests for data on One Care performance, the Council actively engages with MassHealth to increase availability of data for the Council and larger stakeholder community.
The Council continues working with MassHealth and is pressing for: regular financial reporting to monitor the fiscal health of the program, quality measure reporting to ensure the program is meeting the needs and expectations of enrollees, and a comprehensive dashboard to provide enrollees and potential enrollees information about the strengths of each plan in order to assist them in making informed decisions when choosing a plan and when comparing One Care to the fee-for-service system. These tools could also provide MassHealth with an objective means of setting auto assignment goals.
The Council also faces barriers to fulfilling its mission. Council members bring different expertise and strengths to the table from a variety of backgrounds and perspectives that are still underutilized. This is particularly the case in regards to consumer voice and experience as it is difficult to give adequate attention to the wide range of communities that could benefit from further discussion and Council action. Council composition is also a challenge. Following several resignations in 2014, the Council is working with MassHealth to procure members and is making efforts to ensure new members bring needed skill sets and better represent the diversity of the One Care eligible population. Additionally, the Council continues to pursue working relationships with stakeholders including the One Care plans and the One Care Ombudsman Office. While presentations from these partners have been informative they have not been actionable. The Council is committed to partnering with these groups to pursue the shared goal of improving enrollee experience in One Care.
Challenges to the success and sustainability of One Care still remain. To date, the Council has not worked directly with One Care plans. Future work of the Council will include collaborative workgroups with One Care plans to address issues effecting enrollees and to enhance the ability of the Council to monitor the demonstration and make actionable recommendations. Challenges to be addressed in Council workgroups with One Care plans may include reactions to early indicators survey results about enrollee confusion about care coordination, particularly in the provision of LTS coordination, and the purpose of care plans the purpose of care plans as well as reaching and providing adequate services to enrollees who are homeless. The Council is committed to developing an actionable strategy to better understand and address the unique challenges that face enrollees in One Care who are homeless in the coming year. Another area to address is the continued lack of awareness or understanding of One Care among potential enrollees. Other critical challenges to the sustainability of the program include financial concerns resulting from financing structures that are not population-based, the delay in availability of data to measure quality of care, and the continuation of program growth without measurement of the capacity of the healthcare delivery system to meet the complex needs of a population with a thin margin of health or the evidence base to demonstrate that growth will, at a minimum, meet the “do no harm” threshold.
The Council appreciates the increasing collaborative relationship it has with MassHealth and the progress that has been made in the areas of Behavioral Health privacy and early indicators. The 2015 work plan creates a number of opportunities for continued meaningful collaboration between the Council, MassHealth and the One Care plans. The Council also acknowledges the tremendous undertaking of MassHealth staff, and their dedication to the success of the program. The Council also thanks the UMass Medical School staff that provide staff support to the Council.
Sincerely,
Dennis G. Heaphy M.Ed., MPH
Chair, One Care Implementation Council
One Care: MassHealth plus Medicare
The Executive Office of Health and Human Services (EOHHS) and stakeholders across the Commonwealth worked together to develop a demonstration program in partnership with the Centers for Medicare and Medicaid Services (CMS) to integrate care for dual eligible individuals. The initiative, which began enrolling participants in October 2013, integrates the delivery and financing of care for a group of adults, ages 21 to 64 at the time of enrollment who are eligible for both MassHealth and Medicare. One Care is offered in nine Massachusetts counties by three health plans: Commonwealth Care Alliance, Fallon Total Care, and Tufts Health Unify. During 2014, enrollment in One Care increased from 9,506 individuals in January to over 17,900 in December.
Implementation Council Background
EOHHS and stakeholders, consumer advocates in particular, agreed that the collaborative relationships that were key to policy development needed to continue throughout the implementation of One Care. Based on stakeholder input and discussions, EOHHS developed a straw model for the structure, roles and responsibilities of the Council that was further refined through stakeholder engagements. While the composition of the Council and the roles and responsibilities were determined in advance, the Council had the flexibility to develop a work plan based on Council-identified priorities.
Implementation Council Charge
Prior to the start of One Care enrollment, EOHHS convened a working committee called the Implementation Council to play a key role in monitoring access to health care and compliance with the Americans with Disabilities Act (ADA), tracking quality of services, providing support and input to EOHHS, and promoting accountability and transparency.
The Council was formed through a Request for Responses (RFR) process. Interested individuals submitted nomination forms to EOHHS for consideration in December 2012 and the Council began meeting in February 2013. Selection criteria were established to ensure diversity of membership on the Council. A second procurement will occur in 2015 to fill Council vacancies.
Roles and Responsibilities
In their capacity as a working group convened to assist EOHHS in the implementation of One Care, the Council meets monthly to fulfill its roles and responsibilities which include: advising EOHHS; soliciting input from stakeholders; examining One Care plan quality, reviewing issues raised through the grievances and appeals process and Ombudsman reports, examining access to services (medical, behavioral health, and LTSS), and participating in the development of public education and outreach campaigns. The Council provides a vital structure for those affected by the program to participate in the development and improvement of this complex and far reaching health care reform initiative.
Members/Composition
The composition of the Council must be 15 to 21 members, at least half of whom are MassHealth members with disabilities or family members or guardians of MassHealth members with disabilities. Membership also includes advocates and peers from organizations such as community-based organizations, consumer advocacy organizations, service providers, trade organizations and unions. At the start of 2014, 21 members made up the Council. Members of the Council and each person’s affiliation are listed below.
The following individuals serve as consumer representatives (MassHealth members with disabilities or family members or guardians of MassHealth members with disabilities):
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Implementation Council Annual Report - Draft
· Suzann Bedrosian
· Myiesha Demery*
· Joseph Finn
· Anne Fracht*
· Dennis Heaphy (Chair)
· Denise Karuth
· Vivian Nunez
· Jorge Pagan-Ramos*
· Olivia Richard
· Howard Trachtman (Co-Chair)
· Florette Willis (Co-Chair
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Implementation Council Annual Report - Draft
The following individuals serve as representatives of community-based organizations:
· Theodore Chelmow- Consumer Quality Initiatives*
· Audrey Higbee – Center for Human Development*
· Jeffrey Keilson – Advocates, Inc.
· Dale Mitchell – Mass Home Care
· Robert Rousseau – Transformation Center / Fellowship Health Resources
· Peter Tallas – The Arc of Massachusetts*
The following individuals serve as representatives of providers and trade organizations:
· Bruce Bird – The Collaborative: Association for Behavioral Health Care, Association of Developmental Disabilities Providers, and the Provider’s Council
· David Matteodo – Massachusetts Association of Behavioral Health Systems, Inc.
· Daniel McHale – Massachusetts Hospital Association
The following individual serves as a union representative:
· Rebecca Gutman – 1199 SEIU
While individuals selected to be on the Council are the only voting members of the Council, the Council is dedicated to providing a forum for broader stakeholder input in regards to all aspects of the implementation of One Care. This is achieved by having all meetings in public locations, including time on the agenda for participation from meeting attendees at most meetings, and Council members raising issues heard in the community.
*Identified Council members served for most or all of 2014 but resigned in late 2014/early 2015.
2014 Year in Review
Meetings
The Council began meeting in February 2013. Since then, the Council has convened as a full Council 22 times, 10 of which were in 2014. Meetings occur monthly and are 2 hours in length.
Staff support to the Council is provided by staff from the University of Massachusetts Medical School. Staff members assist with meeting planning, accommodations and logistics; producing meeting materials; and supporting the consumer chair, as requested. Accommodations are provided to support all members’ full participation on the Council. Communication Access Realtime Translation (CART) and American Sign Language Interpreters are available at each Council meeting. Stipends and travel reimbursement are made available to Council members who are MassHealth members with disabilities and family members or guardians of MassHealth members with disabilities, who are not paid by a community-based or consumer advocacy organization, provider/trade association, union or another organization/affiliate to represent them.